Provider Demographics
NPI:1932899093
Name:WATSON-BEASLEY, SHELBEY (MSW)
Entity Type:Individual
Prefix:
First Name:SHELBEY
Middle Name:
Last Name:WATSON-BEASLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHELBEY
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1356
Mailing Address - Country:US
Mailing Address - Phone:219-380-6483
Mailing Address - Fax:
Practice Address - Street 1:1000 OAKLAND DR FL 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1282
Practice Address - Country:US
Practice Address - Phone:269-387-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110325104100000X
MI68011172151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker